hauman



A. W. HAUMAN.

INSTRUMENT FOR THE REMOVAL OF HEM'ORRHOIDS AND RESECTION 0F. PROLAPSUSRECTI.

APPLICATl ON nuzn APR. 30. 1919.

1,344,227, Patented June 22, 1920.

3 SHEETS-SHEET I.

W v i 4 I Hi A. W. HAUMAN. I INSTRUMENT FOR THE REMOVAL OF HEMORRHOIDSAND RESECTION 0F PROLAPSUS REST].

APPLICATION FILED K30. 1919.

Patented June 22, 1920.

3 SHEETSSHEEI 2- me/nloz fllexander walkerfiauman A. W. HAUMAN.INSTRUMENT FOR THE REMOVAL OF HEMORRHOIDS AND RESECTION 0F PROLAPSUSRECTI.

APPLICATION FILED APR. 30. 1919.

3 SHEETS-Shh?! 3.

1,344,227. PatentedJune 22,1920.

awuem to c aleacanderwalkerflauman W #M/Ludu UNITED STATES PATENTOFFICE.

ALEXANDER WALKER HAUMAN,

or CAPE TOWN, SOUTH AFRICA.

INSTRUMENT FOR THE REMOVAL OF HEMOR RI-I OIDS AND RESECTION OF PROLAPSUSRECTI.

A lication filed April so,

strument entitled Instrument for. the Re-- moval of Hemorrhoids andResection of Prolapsus Recti, (Prolapse of the Rectum,) of which thefollowing is a specification.

In performing the surgical operation for the removal of hemorrhoids (orpiles) and the resection of prolapsus recti (prolapse of the rectum) theoperator has in the past been greatly handicapped by two difiiculties,namely the heavy flow of blood necessitating constant swabbing and theinsertion of each stitch required without any guide as to the positionthereof, making the operation both a lengthy and difficult one.

I have invented an instrument (which may be styled a hemorrhoid or bowelcircumciser) the use of which renders the operation almost bloodless andgreatly simplifies the same and shortens the duration thereof.

With this specification will be found explanatory drawings on which:

Figure 1 is a perspective view of the in strument.

Fig. 2 is a longitudinal section of the same.

Fig. 3 is a face or front view of the instrument fixed by three fixingneedles passing through tissues and holes.

Fig. 4: is another face or front viewof the instrument in use showingthe ligature being tied around tissues inthe groove D.

Fig. 5 shows the tissue being cut away.

Fig. 6 is another front view showing the stitching and tying of theinterrupted stitches.

Fig. 7 shows the double-length ligatures being put through the threefixing needles to complete the operation- I Fig. 8 shows the operationcompleted with the instrument still in position. v

Fig. 9 shows the rectum with the stitches after removal of theinstrument.

Fig. 10 is a part section showing the mirror.

On the various figures the different parts are lettered as follows: r

F. (Figs. 1 and 2) the face or front end of the instrument, and P thepoint or back handling same. I the instrument is about 11} to 2. inchesbut Specification of Letters Patent. Pate t d J n 22 1920 1919. SerialNo. 293,886.

end. R the body. the slits. o the holes.

D the groove in the collar. fixing needles. T rubber points of theneedles. W tissues to be cut away. L the circular ligature. L the extraligature. M cut margin of tissues. S the stitching needle. L the doublelength ligatures threaded through the three fixing needles. B is themirror.

' The instrument is cylindrical in shape and may be made of any hardmetal, or metal enameled, or of orcelain, although metal is moresuitable. ame is described in connection with the accompanying drawings.One end P, the point (which is regarded as the back end), is cut ontheslant or cone-shaped so as to be easily inserted into the rectum. Itmay either be closed as shown or may be open. If open a swab may beintroduced to prevent any contents from the bowel passing through. Thisend need not necessarily be cut on the slant. It may be cut straight orit may be made to come to a'point. The other end, the face of theinstrument, is circular. Around this end is a collar A around which runsa deep circular groove D. The width and thickness of this collar vary indifferent sized instruments. A good average width is about %ths inch anda good average thickness about ths inch. It is wise to have the groove Dfairly deep. Through this collar and the end of the body of theinstrument, a series of slits, E, are made at regular intervals be solidinstead of hollow, save as to the front portion which should be hollow.A

cross-bar H placed in the instrument about half an inch from the face orfront is for A convenient length for it may be shorter or longer. Auseful circumference for adults is about 41} inches with a collar ofabout 5 inches. For children a smaller size will be necessary.

The slits E are slightly wider at the face or front of the instrumentgradually narrowing down until just where they run into the holes Cbehind the collar. The diameter of the holes is greater than the widthof the slits, so that a needle fitting the holes or able to just passthrough same will not be able to slip forward through the slits. Theportions of the instrument between the slits may be in a straight linewith the body of the instrument but it is better to have them slightlybent or sloped backward or outward from the center as this exposes theinside of the holes better to view when the operator is looking at theface or front of the instrument. The groove D may be of different depths(about or of an inch is a convenient size for adults). It may be narrowor broader depending on the size of the instrument (a width of 5 or -1-of an inch for adult size is convenient).

A detachable mirror 13 may be inserted in front of the cross-bar toenable the operator to get a better view of all the holes. It is notessential but may be of assistance, 6. 9. it enables him to view theuppermost holes without stooping.

Having described the instrument I now give a description of its use inthe operation above referred to.

The rectum is dilated and the instrument introduced with the point Pinward. The parts being on the stretch an incision is carried around theskin and mucous membrane junction, and the cut skin surface is pushedwell back with a wet swab as in -Whiteheads operation, or this portionof the operation may first be completed before the instrument isintroduced. The instrument is next pushed well into the rectum by thecrossbar H and disappears from view. It is then drawn forward again andthe hemorrhoids come well out and cover the face of the instrument inextensive cases, or are pulled forward over the face of the instrumentwith Lane forceps, while the fixing needles hereafter referred to are being introduced. Three fixing needles are now introduced. The firstneedle passes through the skin a little beyond the cut surface, thenthrough the hemorrhoids and mucous membrane, then enters any hole (C) inthe front end F of the instrument. It then passes through the center ofthe instrument and enters a hole diametrically opposite passingoutthrough inucous membrane, pile area and catches the cut skin edge onthe opposite side. If it is remembered that the holes are just behindthe collar there will be no difliculty in getting the needle to enterone. The next needle is then passed in the same way some spaces awayfrom the first so as to cross it and form the letter X. The third fixingneedle is passed in the same way midway between the first two, and asits point crosses the center of the cylinder it must be passed betweenthe first two needles at the point where these first two cross, 2'. e.in front of the one and behind the other. In this way it separates thefirst two needles at that point, and will easily find its owncorresponding hole on the opposite side. This" procedure simultaneouslyfixes all three needles firmly. Fig. 3 shows the three needles G G G inposition looking at the face of the instrument and with their pointscapped with pieces T of rubber. The pile area should be well drawnforward with Lane forceps at the points where the fixing needles enterand pass through. The points of the fixing needles will lie well againstthe skin of the perineum and will not injure the operator. Ordinarystraight cutting needles are used as fixing needles, but they must be ofsuch a size that they will fit through the holes 0 but will not be ableto slip through the slits (E) or else the instrument would slip into therectum. In other words the instrument is so constructed thatthe needlewhich just fits the holes will not be able to slip through the slits.Too thin a needle must therefore not be used. Needles must besufficiently long so that the eye of the needle will remain free.

The operators assistant now pulls on the cross-bar while the operatorties a silk ligature around the mass of piles. This ligature if keptclose to the front aspect of the needles will fall into the groove, D,and the operator ties the mass securely in the groove, leaving the endsof the ligature long and kept out of the way with an artery forcepsclamped on. This is useful when the silk ligature is afterward removed.The silk ligature is easily tied if it is first fixed about its middleto the lowest needle point (or any needle point, and as will later beseen preferably to the one farthest back) by an extra loop of silk alsoleft long. This gives a fixed point to start from. The tying of theligature in the groove D is illustrated in Fig. it. If the needles areproperly fixed and the ligature securely tied then the whole mass ofpiles can now be cut away in one sweep flush with the face of theinstrument, or the operator may cut away in sections as he chooses. Theoperation is almost bloodless. The cutting away is shown in Fig. 5.Interrupted catgut sutures are now inserted through all the vacant holesalways passing the needle from within the cylinder of the instrumentwhere the hole can be distinctly seen. A small weld curved needle S isused and one which will pass throu h the holes C and not through theslits The operator should not rise from his stool while introducingthese sutures once he has attained the method. The needles are handed ona holder. The first stitch goes through a hole to the right (back hand)which the assistant ties and the next to the left which the operatorties, and so on. As the needle emerges on the outer surface, theoperator pulls the cut skin edge over its point with toothed forceps.The ligature slips through the slits and the knots are all tied on topof the groove. Fig. 6 illustrates the stitching and tying of thestitches.

After all the free holes are thus done there remain only the threefixing needles to deal with. These are threaded with double lengthcatgut, for preference the foremost one first, (see Fig. 7). Seize thepoint of this needle and draw it right through the instrument, cut thesuture in the center of the instrument and this will give two sutures insitu. The other two needles are similarly treated. When the two lastsutures are tied the instrument will then be loose and is withdrawn.

In introducing the fixing needles it will be most convenient to firstintroduce the needle G next the needle G to lie in front of the first,and then the third needle G to pass between the other two. This leavesthe first needle G farthest back. The extra silk thread which servedoriginally to fix the circular silk ligature should be tied around thepoint of the first needle G. This enables the operator to knot his silkligature just in front of the eye of the needle G and the ends withforceps clamped will lie on the patient. The suture at the point ofneedle G will be the last one to'be tied and just before tying pull onthe extra silk loop and this will bring the circular ligature into viewout of the groove and it is then cut. The extra silk thread is also thenremoved before tying. By drawing on the knotted end of the circular silkligature it will come away and does not cause any slacking of theinterrupted sutures. A circular catgut ligature may be used instead ofsilk and left in situ, but it is not so secure as a strong silk one. Theoperator should wear cotton gloves so as to tie the catgut sutures veryfirmly and they should be tied with three knots and cut short.

The operation is practically bloodless and can be completed in about 15minutes. The more extensive the case the better will the instrument besuitable. Fig. 8 illustrates a front view of the rectum with theoperation complete.

Cases of prolapsed rectum requiring resec tion are admirably suited bythe instrument. The stitching can be done very rapidly and it is well tohave several needles threaded before commencing.

I claim:

1. A surgical instrument comprising a hollow member having a front partprovided with an external circumferential groove intersected bylongitudinal slits communicatpassage of fixing and surgical instrumentcomprising a hollow member having an external circumferential groove inwhich the tissue may be bound during the operation and having a seriesof holes for the reception of fixing and stitching needles and slits incommunication with such holes, the width of said slits being such as topermit the passage of the stitching medium and prevent the passage ofthe needles.

4. A surgical instrument comprising a hollow member having an externalgroove in which the tissue may be bound and having a series of holes forthe reception of fixing and stitching needles, and a cross bar for usein handling the instrument during the operation.

5. A surgical instrument comprising a hollow body provided with a closedrear end and an open front end and a cross bar near the front to serveas a handle, the front end having a series of holes for the reception offixing and stitching needles, and slots communicating with the saidholes and having a width less than the diameter of the said needles.

6. A surgical instrument comprising a substantially cylindrical bodypart having an open front end and a collar on said front end formed witha series of slits opening into holes for the passage of fixing andstitching needles, said slits having a width less than the diameter ofsaid holes.

7. A surgical instrument comprising a cylindrical body part having aclosed rear end and a flared open front end, a cross-bar near the frontend, and an enlargement at the front end having an external groove inwhich the tissue may be temporarily bound and having holes for thefixing and stitch ing needles and a series of slits for the pas sage ofthe stitching medium.

8. A surgical instrument comprising a body part having an open frontend, a crossbartherein, and a mirror adapted to be mounted on thecross-bar, the front end having a circumferential groove intersected bylongitudinal slits opening into holes for fixing and stitching needles.

In testimony whereof I have hereunto affixed my signature in thepresence of two witnesses.

A. WALKER HAUMAN. Witnesses:

A. E. PHILLIPS, FRANK U. CLIFF.

